Restless Legs Syndrome (RLS)

Definition

Restless legs syndrome (RLS) is a condition marked by abnormal movements of the legs, sometimes accompanied with abnormal sensations in the legs. These movements and sensations make the patient very uncomfortable, impact on the quality of sleep and can even result in sleep deprivation and stress.

Restless legs syndrome is defined as a sensorimotor disorder, which means it affects both, sensory (sensation-related) and motor (movement-related) pathways. Typical signs of restless legs syndrome are most prominent around the evenings or after periods of inactivity. Though it can start at any age, RLS generally affects people in middle and older age more.

It is important to note that restless leg syndrome is a specific condition and should not be confused with odd night or two of restless sleep, night terrors and other sleeping disorders.

Symptoms

Restless legs syndrome may not be a painful condition, although it is a bothersome disease. People suffering from restless legs syndrome show the following symptoms :

  • An irresistible urge to move the legs
  • Feeling creeping or crawling sensations in the legs
  • Pain in the legs (less common)
  • Symptoms more prominent after periods of inactivity or while lying down
  • Severity of symptoms maximum around bedtime
  • Stretching, kicking, or walking (to provide relief from the symptoms)
  • Difficulty falling asleep and/or repeated awakenings in night

Causes

The exact mechanism behind this movement is not clear, however, abnormalities in transmission of a neurotransmitter dopamine may be playing a role in the development of restless legs syndrome.

The condition may also occur in patients on drug withdrawal, in patients on certain antidepressants or stimulants, in women during pregnancy, or in patients with chronic kidney or liver failure, anemia, iron deficiency, and other disorders.

Heredity may also play a role in RLS but the exact manner is unclear. Factors that increase the risk of developing restless legs syndrome include a sedentary lifestyle, obesity, and smoking.

Treatment

Medication

  • Dopaminergic drugs (like pramipexole and ropinirole) are recommended to patients with restless legs syndrome. However, these drugs may have side-effects like nausea, sensations of dizziness upon standing, and sleeplessness. They may result in shifting the appearance of symptoms earlier in the day. Also, symptoms may worsen after stopping these drugs.
  • Pramipexole and ropinirole are given around 2 hours before bedtime.
  • Benzodiazepines (like clonazepam, triazolam, eszopiclone, ramelteon, temazepam, zaleplon, and zolpidem) may improve sleep continuity at night but they are ineffective on abnormal leg sensations. They may also cause daytime sleepiness.
  • Opioids or other narcotics are effective in providing relief from mild to severe symptoms, but are used with caution due to their high abuse potential. Also, the higher doses of narcotics nay develop addiction.
  • Some patients show improvement upon taking anti-epileptic medications (like gabapentin). In patients with restless legs syndrome and pain, gabapentin is given around bedtime to relieve the symptoms.
  • Iron supplements are given to patients showing iron deficiency.

Lifestyle measures

Simple lifestyle measures can help in managing the symptoms of restless legs syndrome. Such measures may include the following:

  • Maintaining good sleep hygiene
  • Avoiding stress and fatigue
  • Learning relaxation techniques
  • Abstinence from smoking
  • Reducing excess body weight
  • ┬áIncluding moderate exercises in daily routine
  • Avoiding drug abuse and alcohol

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